Advertisement

Journal of General Internal Medicine

, Volume 33, Issue 1, pp 116–119 | Cite as

Warm Handoffs: a Novel Strategy to Improve End-of-Rotation Care Transitions

  • Harry S. Saag
  • Jingjing Chen
  • Joshua L. Denson
  • Simon Jones
  • Leora Horwitz
  • Patrick M. Cocks
Innovation and Improvement: Innovations in Medical Education

ABSTRACT

Background

Hospitalized medical patients undergoing transition of care by house staff teams at the end of a ward rotation are associated with an increased risk of mortality, yet best practices surrounding this transition are lacking.

Aim

To assess the impact of a warm handoff protocol for end-of-rotation care transitions.

Setting

A large, university-based internal medicine residency using three different training sites.

Participants

PGY-2 and PGY-3 internal medicine residents.

Program Description

Implementation of a warm handoff protocol whereby the incoming and outgoing residents meet at the hospital to sign out in-person and jointly round at the bedside on sicker patients using a checklist.

Program Evaluation

An eight-question survey completed by 60 of 99 eligible residents demonstrated that 85% of residents perceived warm handoffs to be safer for patients (p < 0.001), while 98% felt warm handoffs improved their knowledge and comfort level of patients on day 1 of an inpatient rotation (p < 0.001) as compared to prior handoff techniques. Finally, 88% felt warm handoffs were worthwhile despite requiring additional time (p < 0.001).

Discussion

A warm handoff protocol represents a novel strategy to potentially mitigate the known risks associated with end-of-rotation care transitions. Additional studies analyzing patient outcomes will be needed to assess the impact of this strategy.

KEY WORDS

care transitions patient safety medical education-graduate 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.

REFERENCES

  1. 1.
    Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168:1755–1760.CrossRefPubMedGoogle Scholar
  2. 2.
    Riesenberg LA, et al. Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med J Assoc Am Med Coll. 2009;84:1775–1787.CrossRefGoogle Scholar
  3. 3.
    Starmer AJ, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013;310:2262–2270.CrossRefPubMedGoogle Scholar
  4. 4.
    Starmer AJ, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803–1812.CrossRefPubMedGoogle Scholar
  5. 5.
    Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff. Qual Saf Health Care. 2009;18:248–255.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rich EC, Gifford G, Dowd B. The effects of scheduled intern rotation on the cost and quality of teaching hospital care. Eval Health Prof. 1994;17:259–272.CrossRefPubMedGoogle Scholar
  7. 7.
    Smith JP, et al. Effects of end-of-month admission on length of stay and quality of care among inpatients with myocardial infarction. Am J Med. 2002;113:288–293.CrossRefPubMedGoogle Scholar
  8. 8.
    Denson JL, McCarty M, Fang Y, Uppal A, Evans L. Increased mortality rates during resident handoff periods and the effect of ACGME duty hour regulations. Am J Med. 2015;128:994–1000.CrossRefPubMedGoogle Scholar
  9. 9.
    Denson JL, et al. Association between end-of-rotation resident transition in care and mortality among hospitalized patients. JAMA. 2016;316:2204–2213.CrossRefPubMedGoogle Scholar
  10. 10.
    Streitenberger K, Breen-Reid K, Harris C. Handoffs in care—can we make them safer? Pediatr Clin N Am. 2006;53:1185–1195CrossRefGoogle Scholar
  11. 11.
    Chaboyer W, et al. Bedside handover: quality improvement strategy to ‘transform care at the bedside’. J Nurs Care Qual. 2009;24:136–142.CrossRefPubMedGoogle Scholar
  12. 12.
    Cairns LL, Dudjak LA, Hoffmann RL, Lorenz HL. Utilizing bedside shift report to improve the effectiveness of shift handoff. J Nurs Adm. 2013;43:160–165.CrossRefPubMedGoogle Scholar
  13. 13.
    Taylor J. Improving patient safety and satisfaction with standardized bedside handoff and walking rounds. Clin J Oncol Nurs. 2015;19:414–416.CrossRefPubMedGoogle Scholar
  14. 14.
    Sehgal N. Annual Perspective 2014: Handoffs and Transitions. Agency for Healthcare Research and Quality Patient Safety Network. 2015. http://psnet.ahrq.gov/perspective.aspx?perspectiveID=170.
  15. 15.
    Bernabeo EC, Holtman MC, Ginsburg S, Rosenbaum JR, Holmboe ES. Lost in transition: the experience and impact of frequent changes in the inpatient learning environment. Acad Med. 2011;86:591–598.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Harry S. Saag
    • 1
  • Jingjing Chen
    • 2
  • Joshua L. Denson
    • 3
  • Simon Jones
    • 4
  • Leora Horwitz
    • 1
    • 4
  • Patrick M. Cocks
    • 1
  1. 1.Department of General Internal Medicine and Clinical InnovationNYU Langone Medical Center and NYU School of MedicineNew YorkUSA
  2. 2.NYU School of MedicineNew YorkUSA
  3. 3.Division of Pulmonary Sciences and Critical CareUniversity of Colorado School of MedicineDenverUSA
  4. 4.Department of Population HealthNYU School of MedicineNew YorkUSA

Personalised recommendations